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Organization
EMG
Active
Organization
EMG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY WINEGAR MD (MEDICAL DIRECTOR)
(619) 444-7454
Entity
Organization
Contact information
Practice address
10225 AUSTIN DR, STE #103, SPRING VALLEY, CA 91978-1500
(619) 660-6719
(619) 660-5934
Mailing address
10225 AUSTIN DR, STE #103, SPRING VALLEY, CA 91978-1500
(619) 660-6719
(619) 660-5934
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16585
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W11716
MEDICARE CROUP #
—
Enumeration date
11/02/2006
Last updated
06/20/2008
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